Puerperal Eclampsia

1893 Boston Medical and Surgical Journal  
entrance wound with cotton saturated with corrosivesublimate solution. The patient rallied well, and in the afternoon seemed fully as comfortable as before the operation. The cotton plug was removed, the wound syringed with corrosive-sublimate solution, and plugs of necrosed tissue removed by forceps. There had been some sweating. His pulse varied from 88 to 90, and whb rather weak; temperature 100.2°. When a night visit was made on this same day, little change was noticed, except that the left
more » ... eye (which the swelling had succeeded in closing iu the early morning) waB even more tightly closed. On the following day the patient was no worse ; in fact, there was scarcely any change. Plugs of necrosed tissue were removed, and the same treatment carried out. The symptoms wore improved on the following day. The patient had slept without opium, and the necrosed tissue came away more freely. It was a disappointment to learn at tho visit in the afternoon (3 o'clock) that a third focus had started on the left cheek on a level with tho angle of the mouth. Thia was hard and tender. The breath was offensive, but the general condition was good. This spot extended in its progress along the lower border of the inferior maxilla, ' involving the lower lip as far forward as the median line. The area which at this time was involved measured two and one-half by three inches, practically the whole of the left side of the face. No further cutting was done, but by forcing lines of communication from one focus to another, by means of a director and probe, it was possible to reach the whole diseased area by injection with the syringe ; and later the necrosed tissue was pressed out from the lower angle of the jaw through the opening first noticed. His recovery was gradual. He was able to sit up for a while on November 30th, after which date convalescence was rapid, so that he was discharged well, December 3d. Almost no scar remained, and none which is not now covered by his mustache. It must bo conceded, I think, that this is one of the most dangerous and alarming conditions to be met with in the practice of obstetrics. It destroys more lives than any other puerperal affection, iu proportion to frequency. Statistics are not very reliable on this aubject ; but taking a moderate catimate, it probably occura once in four or five hundred deliveries, with a mortality of about thirty per cent, for the mothers and fifty per cent, for the children, although aome authors place it much higher. In an experience of two thousand obstetric cases, eclampsia was encountered three times, twice at the commencement and once before labor, and all were primípara who were suffering from albuminuria. One of the patients was very dropsical ; aud owing to the difficulty of re-establishing the function of her kidneys, complications rapidly followed, which caused her death. The other two slowly but perfectly recovered ; one has 1 Read before the Cambridge Society for Medical Improvement, May 22, 1893. been delivered since of twins and enjoys good health, whereas the other, who was delivered last December, and apparently made a good recovery, is suffering from chronic parencliymatous nephritis, which, judging from a recent examination of the urine, is in the inactivo stage. Two of the children were born dead, the other dying on the third day. This is not a very brilliant showing ; and yet it would seem that, in the light of modern science and with tho wisdom of the ages to guide us, one ought to be able to cope more succesfully with this terrible malady. Our literature is replete with theories relating to the mysteries which surround its etiology and therapy ; but considering that the questions are still sub judice, we take up each new journal wondering what the next speculator will have to say. From the repletion and depletion theory of Hippocrates to the bacteriological theory of Gerdes is quite a lapse of time ; but it requires very little knowledge to enable one to appreciate the clinical value of the ancient as compared with this modern view of the subject. From a study of the works of different authors and a limited bedside experience, it would seem that we are in possession of all the theories for the explanation of the obstetric phenomena. The difficulty all along appears to have come from trying to make one or two factors do what it takes several to accomplish. We have been taught so long to consider eclampsia as closely allied to albuminuria, that disturbance of functions, other than those of the kidneys, baa received but indifferent attention until within a comparatively short time. It is not to be inferred that this is not an important factor, but that the renal affection alone rarely is sufficient to produce convulsions. It is only a part of a whole, a collective cause, the other parts consisting of pregnancy-usually the firsta watery condition of the blood, and high nervous tension. It is a matter of common observation that women looking forward to first motherhood suffer more from excitability of the nervous system and from emotional disturbances than they do in subsequent ones ; and when it is realized that this state of things is kept up, perhaps for weeks, exhausting the nervous system and lessening the power of resistance, it is easy to conceive how favorable the conditions are for an explosion, particularly after the noxious elements begin to accumulate, through faulty elimination, whether it be due to pressure on the ureters, renal insufficiency pure and simple, hypenemia, or acute or chronic nephritis. The treatment of eclampsia is as varied aa ita etiology. For the aake of brevity the various means may be enumerated as follows : (1) chloral or chloroform, (2) morphine, (3) venesection or veratum viride, (4) induction of labor. Of course, other medication is called for, such as cathartics, diuretics, diaphoretics, cold to the head, sinapisms to tho extremities, and proper conditions of temperature and ventilation, according to the special indications of the case. As the trouble may appear before, during, or after labor, an opportunity is offered for the exercise of good judgment in the selection of the right method or methods of treatment. Owing to a lack of experience, the third class or post-partum form will not be discussed. In the second class of cases, which is by far the most numerous, the consensus of opinion seems to be in favor of hastening delivery. I adopted this teaching in two cases of this class, but do not think I would
doi:10.1056/nejm189310261291703 fatcat:ypewp6ufrjbpxl7zk7vynwtf5u